Skeletal and Surgical Evidence for Acute Osteomyelitis in Non‐Adult Individuals

Abstract

Osteomyelitis is a non-specific infection of bone and bone marrow. In the past acute osteomyelitis (AO) led to high mortality especially in non-adults. Nevertheless, its diagnosis in archaeological populations is rare. Documented individuals with known cause of death offer a unique opportunity to study this condition. This paper aims to describe the bone lesions in non-adults diagnosed with AO at the Coimbra University Hospital (CUH) and now belonging to the Coimbra Identified Skeletal Collection (CISC). Moreover, mortality rates and demographic profiles for individuals aged ≤18 years old and diagnosed with AO in the CUH, between 1923 and 1929, were also determined. The 5 (1%) non-adults in the CISC with AO listed as cause of death were selected for this study and their bones were analysed macroscopically and radiologically. The skeletal remains of one individual revealed a small area of new bone formation in the shaft of the left femur. Radiography of this bone showed a radio-opaque area in the diaphysis. The other four individuals show evidence of surgical treatment, responsible for many cases of disability in the past. In the 7-year period under analysis, 122 juveniles were diagnosed with osteomyelitis and admitted for surgery at the CUH, 43 (35.2%) of which were diagnosed with AO. Sixty-five percent of the cases of AO occurred between the ages of 8 and 15 years, with males twice as frequently affected as females, and lower limb bones were involved in 91% of AO cases. AO was responsible for 76.9% of the deaths. This study of pre-antibiotic non-adults may help to recognize skeletal signs of AO and their surgical treatment in unidentified skeletal remains.

Differentiating between rhinosinusitis and mastoiditis surgery from postmortem medical training: A study of two identified skulls and hospital records from early 20th century Coimbra, Portugal

“…Carty, 2013;Powers, 2005;Santos and Suby, 2015), it can be difficult to accurately diagnose when performed close to the death of a patient (e.g. Dittmar and Mitchell, 2015;Santos and Suby, 2015) before bone start remodeling, and thus may be confused with postmortem medical examinations such as autopsy, dissection, and prosection. To distinguish between these procedures can also be challenging, because all of them take place after the death of the individual.…”

Assessing the physical and pathological traits of human skeletal remains from cemetery localities at the Rakhigarhi site of the Harappan Civilization

“…Obviously, new bone formation tends to enclose the infected area caused by osteomyelitis (Mast and Horwitz, 2002). As a serious health problem, osteomyelitis is defined as an infection of the bone and bone marrow resulting in inflammation, necrosis, and new bone formation, and is commonly observed from the pre-antibiotic era (Santos and Suby, 2015). However, the poor preservation condition of this case did not allow us to definitively diagnose whether the femoral osteomyelitis was a non-hematogenous or hematogenous type of osteomyelitis.…”

Digital radiography and historical contextualisation of the 19th century modified human skeletal remains from the Worcester Royal Infirmary, England

“…Differential diagnoses are then made on the basis of these classifications. It should be noted that the very early stages of acute bone disease may not be detected using DDR (Santos and Suby, 2012); it has been estimated that radiography is 67% specific and 60% sensitive for detecting osteomyelitis, such as represented by permeative and moth-eaten changes, with destructive changes following a 30-50% loss of bone mineralisation before materialisation on radiographs (Berry and Gulati, 2005;Pineda et al, 2009;Hobizal and Wukich, 2012). However, bone destruction may be detected one week after, and periosteal reactions two weeks after, its initial onset (Burgener et al, 2006;Pineda et al, 2009).…”